Premature ejaculation is one of the most common problems of men related to sexual function, but it affects both partners. The causes can be psychological and/or organic, which is why a multidisciplinary approach to treatment is often necessary. Treatment includes learning techniques to delay ejaculation, medication and psychological counseling. Urological treatment establishes the possible cause and indicates the best way to treat the symptoms.
What is Premature Ejaculation?
Premature ejaculation is a sexual dysfunction characterized by the ejaculation occurring always or nearly always before or within one minute of vaginal penetration.
Variable (occasional) and subjective premature ejaculation are not considered disorders. Subjective premature ejaculation is when a man has the impression of premature ejaculation, i.e. insufficient control over the desired time of ejaculation, even though penetration lasts longer than a minute.
Considering the time of occurrence, premature ejaculation is divided into primary and secondary. Ejaculation can be primary, present from the first sexual encounter and occurring regularly, or secondary, which develops later in life after having experienced expected ejaculation timing.
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What Causes Premature Ejaculation?
The causes of premature ejaculation can be psychological, organic, or a combination of both. Psychological causes may include:
- Anxiety or performance-related anxiety
- Stress
- Depression
- Relationship problems
- Previous traumatic sexual experiences
- Negative personal beliefs about sexual relations
Organic causes may include:
- Over-sensitive penile skin
- Short or tight frenulum
- Prostate diseases (such as prostatitis or benign prostatic hyperplasia)
- Urethritis (inflammation of the urethra)
- Hyperthyroidism (increased thyroid gland activity)
- Certain neurological disorders
How is Premature Ejaculation Treated?
For the diagnosis of premature ejaculation, it is necessary for a specialist urologist to take all the medical history and perform a clinical examination in order to rule out a possible organic cause.
Treatment for premature ejaculation may require a multidisciplinary approach involving a urologist, psychologist, and sexual therapist. If there is no organic cause of premature ejaculation, treatment is symptomatic and includes teaching the patient behavior modification techniques and taking medication to delay ejaculation. Various treatment methods are available depending on the cause:
Behavioral Techniques:
The purpose of behavior change techniques is to reduce anxiety and control the timing of ejaculation so that it can be delayed.
There are two ways: the stop and start technique and the squeezing technique. In both techniques, it is necessary to monitor the level of excitement in order to stop the relationship at a crucial moment. Although they require a lot of practice, most men achieve successful results with these techniques.
Stop-Start Technique: Sexual activity is stopped when the sensation of impending ejaculation is felt and resumed after 30 seconds. This method can be repeated multiple times before ejaculation.
Squeeze Technique: Sexual activity is stopped when the sensation of impending ejaculation is felt, the tip of the penis is squeezed for 10 to 20 seconds, and then resumed after an additional 30 seconds. This technique also requires practice and can be repeated multiple times.
Pharmacological Treatment:
Selective Serotonin Reuptake Inhibitors (SSRIs): These antidepressants, such as dapoxetine, can help delay ejaculation. Currently, the only targeted drug registered for the treatment of premature ejaculation is dapoxetine.
Local Anesthetics:
Gels or creams with local anesthetics can reduce the sensitivity of the glans penis and help delay ejaculation. They should be applied 15–30 minutes before intercourse. This type of treatment requires the use of a condom or rinsing of the penis before penetration in order not to reduce vaginal sensation.
Psychotherapy:
If psychological issues are the cause, psychotherapy can address these issues and improve self-confidence in sexual relationships.
Surgical Approach:
If a short frenulum is identified as the cause, frenuloplasty (surgical incision of the frenulum) may be recommended to address the issue. If you have symptoms of a tense frenulum and a specialist urologist determines the diagnosis through a clinical examination, the solution for premature ejaculation could be frenulotomy, that is, surgical cutting of the frenulum.
Despite possible discomfort and embarrassment due to the nature of the problem, going to the doctor is important for establishing a diagnosis and starting treatment as early as possible. Delaying seeking help only prolongs the time during which both partners are potentially stressed and dissatisfied. It is important to point out that there are solutions for premature ejaculation, and the first step is a specialist examination by a urologist, who will help you with this.
Cost of Diagnosis and Treatment of Premature Ejaculation
For additional questions or to schedule an appointment with our urologist, please contact us by phone at +385 1 5005 970 or email us at info@sinteza.hr.
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